this presentation is uploaded specially for the Nursing Faculties and paramedics regarding the Body Mechanics specially in the subject Nursing Foundation , Unit- X. it is also useful to common people about poor body posture in relation to their occupation and adverse effect of poor body mechanics, it is also useful to all nursing officers and para medics.
1. Prepared by: SANJAY SIR
Lecturer
Govt. College of Nursing
New Civil Hospital
SURAT-395006
Gujarat
INDIA
(M) 9824961594
SUBJECT: NURSING FOUNDATION
UNIT: X- MEETINGTHE NEED OFTHE PATIENT
MOBILITYAND IMMOBILITY
2. Body Mechanics
The efficient, coordinated, and safe use of the body to
produce motion and maintain balance during activity.
Body mechanics involves the coordinated effort of muscles,
bones, and the nervous system to maintain balance, posture, and
alignment during moving, transferring, and positioning patients.
Purpose :
To facilitate safe and efficient use of appropriate groups of muscles.
3. The Importance of Proper Body Mechanics - Keeping
Your Spine Healthy. Body mechanics is a term used to
describe the ways we move as we go about our daily
lives. It includes how we hold our bodies when we sit,
stand, lift, carry, bend, and sleep. Poor body
mechanics are often the cause of back problems
4. Some strategies to Prevent Back Injuries:
1. Wear low-heeled shoes that provide good foot
support
2. When standing for long periods,occasionally flex
one hip and knee and rest your foot on an object if
possible
3. Sit with knees slightly higher than hips
4. Exercise regularly, including exercises to strengthen
the pelvic, abdominal, and lumbar muscles
5. Sleep on a firm mattress
13. Body alignment (posture): geometric
arrangement of body parts in relation to each
other.
Balance (stability): state of equipoise
(equilibrium) in which opposing forces
counteract each other.
Coordinated body movement: integrated
functioning of the musculoskeletal and
nervous system as well as joint mobility.
14. The center of gravity of an object is the center of its
mass. In humans, it is at the center of the pelvis
about midway between the umbilicus and the
symphysis pubis.
The line of gravity is the vertical line passing through
the center of gravity.
The base of support is the foundation that provides
the object/person’s stability.
15. The wider the base of support and the lower the center of gravity, the
greater is the stability of the object.
The equilibrium of an object is maintained as long as the line of gravity
passes through its base of support
When the line of gravity shifts outside the base of support, the amount
of energy required to maintain equilibrium is increased
Equilibrium is maintained with least effort when the base of support is
broadened in the direction in which movement occurs.
Stooping with hips and knees flexed and the trunk in good alignment
distributes the work load among the largest and strongest muscle groups
and helps to prevent back strain.
The stronger the muscle group, the greater is the work it can perform
safely.
16. Using a larger number of muscle groups for an activity
distributes the work load.
Keeping center of gravity as close as possible to the center of
gravity of the work load to be moved prevents unnecessary
reaching and strain on back muscles.
Pulling an object directly toward (or pushing directly away
from) the center of gravity prevents strain on back and
abdominal muscles.
Facing the direction of movement prevents undesirable
twisting of spine.
Pushing, pulling, or sliding an object on a surface requires
less force than lifting an object, as lifting involves moving the
weight of the object against the pull of gravity.
17. Moving an object on a level surface requires less effort than
moving the same object on an inclined surface because the pull of
gravity is less on a level surface.
Working with materials that rest on a surface at a good working
level requires less effort than lifting them above the working
surface.
Contraction of stabilizing muscle preparatory to activity helps to
protect ligaments and joints from strain and injury.
Dividing balanced activity between arms and legs protects the
back from strain.
Variety of position and activity helps maintain good muscle tone
and prevent fatigue.
Alternating periods of rest and activity helps prevent fatigue.
18. Moving an object by rolling, turning, or pivoting requires less
effort than lifting the object, as momentum and leverage are used
to advantage.
Using a lever when lifting an object reduces the amount of
weight lifted.
The less the friction between the object moved and surface on
which it is moved, the smaller is the force required to move it
19. Growth and Development
Physical Health
Mental Health
Nutrition
Personal Values and Attitudes
External Factors
Prescribed Limitations
20. Cardiovascular – decreased heart reserve, venous stasis, orthostatic
hypotension,thrombophlebitis, dependent edema (lower limbs will
swell)
Respiratory – difficulty breathing, pulmonary embolism, pneumonia,
decreasedvital capacity, decreased chest expansion
Musculoskeletal – atrophy, contracture, osteoporosis, decreased
muscle tone, size,strength
Metabolic – gain weight, negative N balance, protein synthesis
(anabolism)exceeded by breakdown (catabolism), kidneys affected
Gastrointestinal – slow down, decreased appetite & peristalsis
Urinary – urine pool in kidneys get U.T. I.
Skin – pressure ulcer risk
Psychosocial – isolation, low self-esteem
21. When sitting, particularly supported and/or with
poor posture, muscle and connective tissue
become altered due to the plastic properties of the
tissue that gives in to gravity. As a result we walk
without proper body mechanics(specifically
alignment) resulting in pain and injuries.
23. Prevention Of Musculoskeletal Complications
Goal:
• Prevent contractures, muscle
weakness/atrophy.
• Prevent disuse osteoporosis
Interventions:
Provide Active or passive range of motion
exercises(ROM ) three times/day.
Encourage activities of daily living(ADLs) as
possible and progressively.
24. Promote independence as much as possible.
Provide Therapeutic devices as needed.
(pillows, footboard, trochanter roll, hand rolls,
trapeze bar).
Consult appropriate health care provider
(e.g. physician, physical therapist) if client's
mobility and range of motion are more limited
than expected.
Provide foods high in calcium
Prevention Of Musculoskeletal Complications
25.
26. Prevention of cardio vascular complications
Goal:
• Reducing orthostatic hypotension
• Reducing cardiac workload
• Preventing thrombus formation
Interventions:
Reducing orthostatic hypotension-
Teaching patients to rise slowly from lying
to standing. Sit for a while before standing
27. :
Reducing cardiac workload:
• Discourage Valsalva maneuver.
• Encourage patient to take breath while
sitting or standing.
• Stool softeners to avoid straining during
defecation.
Preventing thrombus formation.
Exercise: perform active / passive exercises.
Prevention of cardio vascular complications
28. Prevention of cardio vascular complications
Provide at least 2000 ml water daily.
Encourage early mobilization.
•Medication:
Aspirin or antiplatelet agents should be given.
•Compression stockings, sequential compressive
devices must be used.
•Positioning:
Avoid crossing the legs, sitting for prolonged
period of time wearing clothing that constricts the
leg.
:
29. Prevention of respiratory complications
Goal
• Promotion of chest and lung expansion
• Removal of secretions
• Maintenance of patent airway
• Prevention of hypostatic pneumonia
30. Interventions:
Place the client in fowlers position.
Cough and deep breathing.
Ambulate as soon as possible.
Adequate fluid intake.
Incentive spirometer.
Chest physiotherapy.
Prevention of respiratory complications
31.
32. Prevention of metabolic complications
Goal:
• To prevent negative nitrogen and calcium
balance
• To meet the nutritional requirements
Interventions:
Nutritional needs:
Provide protein rich diet
Supply adequate calories in diet
Vitamin D, C rich diet.
33. Prevention of urinary complications
Goals:
• Prevent urinary stasis, calculi, and infection.
Interventions:
Ensure adequate fluid intake (minimum 2L/day).
provide Toileting aids.
Foley’s or straight catheter if needed.
Observe output, assess for bladder distention, signs
and symptoms of urinary tract infections (UTI).
34. Prevention of gastrointestinal effects
Goal:
• Prevention of constipation
Interventions:
• Encourage daily fluid intake of 2000 to 3000 ml per
day, if not contraindicated medically
• Encourage increased fiber in diet (e.g., raw fruits,
fresh vegetables); a minimum of 20 gm of dietary
fiber per day is recommended
35. Encourage physical activity and regular exercise
Encourage a regular time for elimination
Offer a warmed bedpan to bedridden patients
Provide privacy and maintain dignity
Stool softeners
Suppositories
Enema
Prevention of gastrointestinal effects
36. Prevention of Integumentary complications
Goal:
• To prevent skin breakdown
Interventions:
Change position every 2nd hourly.
Use proper transfer technique to avoid
shearing/friction.
37. Therapeutic devices as needed (air mattress, water
mattress, protective cushion, pressure rings, etc.)
Adequate hydration and nutrition
Protect skin from moisture.
Assess skin for signs of pressure areas/skin
breakdown.
Proper wound care.
Prevention of Integumentary complications
38.
39. Prevention of psychosocial complications
Goal:
• To improve self esteem
• To avoid depression
Interventions:
Provide psychological support.
Encourage client’s verbalization of feelings.
40. Provide social interaction during care
encourage participation in ADLs as able
Provide stimuli to promote orientation and
contact with reality – clock, radio, TV,
newspaper.
Prevention of psychosocial complications
41. Common hazards of immobility and its management
1. Pressure Ulcers -
A pressure ulcer is a specific tissue
injury caused by unrelieved
pressure that results in ischemia in
and damage to the underlying
tissue.
Pressure ulcers occur most
commonly over bony prominences.
Risk factors include:
1.immobility
2.malnutrition
3.incontinence
4.compromised peripheral
circulation.
The elderly are especially at risk
because of a loss of lean body mass
and changes in body tissues and
peripheral circulation.
“Bed Sore”
45. Pressure Ulcers
Stage 4
damage to
muscle, bone,
tendon or
joint capsule;
small or large
surface
wound, but
with extensive
tunneling, and
foul smelling
discharge.
46. Nursing Measures to prevent
Pressure Sores:
Frequent turning of immobile clients every 2 hours
Instruct patients to do weight shifts (pressure relief ) at
least every 15-20 minuteswhen sitting in your
wheelchair.
If your injury is at levels C4 and higher you can use a
power tilt wheelchair for regular pressure relief.
With an injury at levels C5 or C6 you can usually lean
forward or side-to-side for regular pressure relief.
If your levelof injury is C7 and below you can usually
perform a wheelchair push-up for regular pressure relief.
47. Nursing Measures to prevent
Pressure Sores:
Provide for good nutrition with diet high in protein,
carbohydrates, fluids, vitamin C and zinc
Use alternating-pressure air mattress, flotation pads,
elbow and heel pads, sheepskin pads
Do not use “donuts” or rubber rings
Protect from infection
48. Nursing Measures to prevent
Pressure Sores:
Wash skin gently, pat dry to prevent skin abrasion
Use clean, dry, wrinkle-free bed linens and pads
Promote circulation by gently massaging skin with
lotion that does not contain alcohol
Remove dead tissue and debris for stages 2-4
Dead tissue in the pressure sore can delay healing and
lead to infection. Removing dead tissue is often painful.
The client may be given pain-relieving medicine 30 to 60
minutes before these procedures.
49. Nursing Measures to prevent
Pressure Sores:
Procedure
Rinsing (to wash away loose debris).
Wet-to-dry dressings.
Enzyme medications to dissolve dead tissue only.
Special dressings
Complications of pressure sores include localized (i.e.
osteomyelitis, cellulitis) and even systemic infection
(i.e. sepsis)
51. Bone Demineralization and
Hypercalcemia
Nursing Measures:
Prevent injury related to dec. bone strength
Encourage weight-bearing on long bones, if possible
Correct Body alignment, firm mattress
Encourage self – care, ROM, avoid fatigue
Assume wt. bearing positions (Tilt Table)
Decrease calcium intake, provide balanced diet
Diet: high CHO, Vit.C, Dec. Ca
May be given estrogen, as necessary, and medications like
biphosphonates (i.e. alendronate, residronate) to retard
demineralization
Encourage fluids, acid-ash diet
52. Negative Nitrogen Balance
Negative nitrogen balance is aggravated by anorexia. It
represents depletion of protein stores that are essential
for building muscle tissue and for wound healing.
Nursing Measure: Give high protein diet in small,
frequent feedings
53. Orthostatic Hypotension
Orthostatic hypotension is decrease in BP > 20/10 mmHg
and it happens when there is decreased ability of the
autonomic nervous system to equalize the blood supply
when position is changed from recumbent to upright.
Another contributing factor is the pooling of blood in the
lower extremities due to the decrease in muscle action that
causes pressure on the veins and assisting in venous return.
May lead to faintness, weakness, or dizziness in an attempt
to stand. The patient is at high risk for injury due to falls.
54. Orthostatic Hypotension
Nursing Measures:
Increase activity gradually
Encourage ROM and leg exercises
Teach patient to rise from bed slowly and dangle legs
before getting up
Elastic stockings
Tilt table
Sitting & lying BP
55. Increased Cardiac Workload
When the body is recumbent, the
total blood volume that would be in
the legs due to gravity is redistributed
to other parts of the body, increasing
the circulating volume and workload
of the heart.
With prolonged immobility the
sympathetic nervous system takes
over resulting to tachycardia
56. Increased Cardiac Workload
Valsalva maneuver further increases cardiac workload
Nursing Measures: Goal is to prevent injury and
further ischemic damage to cardiac tissue by
decreasing workload of heart:
Semi-recumbent position when in bed, pillows between
legs when side-lying
Passive & Active ROM exercises
Turn every 2 hour, dangle legs
Avoid Valsalva maneuver: use overhead trapeze when
moving in bed
Encourage slow, deep breathing when moving in bed
57. Contractures
Contractures are joint abnormalities
due to abnormal shortening of muscle
tissue, rendering the muscle highly
resistant to stretching.
Due to lack of active or passive ROM
and improper positioning of joints
On assessment: fixed, shortened
extremities with pain on manipulation
Leads to difficulties in performing ADL
58. Contractures
Nursing Measures:
Promote frequent change in position
Use pillows, trochanter rolls, and
foot board to promote proper body
alignment
Avoid knee gatch
Perform therapeutic ROM exercises
as appropriate
Promote proper body alignment
Position: Functional, correct
alignment
59. Thrombus Formation
This is development of clot in a
vein due to venous stasis,
increased coagulability of blood
and damage to the endothelial
wall of the vessel
DVT present as groin or calf
tenderness, pain, warm and
edematous extremities. It poses the
danger of throwing off an emboli
leading to pulmonary infarction
60. Thrombus Formation
Nursing Measures:
Prevent by leg exercises: flexion and extension of toes
for 5 minutes every hour
Ambulate patients as appropriate
Avoid using knee gatch on bed or pillows to support
knee f lexion
Use anti-thromboembolic stockings
Check for Homan sign
61. Stasis of Respiratory Secretions
Due to inability of cilia to move normal secretion out
of bronchial tree due to ineffective coughing, lack of
thoracic expansion or effects of medications
This leads to hypostatic pneumonia (frequent
nosocomial infection)
62. Stasis of Respiratory Secretions
Nursing Measures:
Teach patient the importance of turning,
deep breathing, coughing
Teach patient how to use incentive
spirometry
Hold the spirometer upright
Teach patient to exhale first and seal the lips
tightly around the mouthpiece
Take in a slow, deep breath to elevate the balls or
cylinder. Hold the breath initially for 2 seconds
and then increasing to 6 seconds.
Repeat the procedure four or five times hourly.
Practice increases inspiratory volume, maintains
alveolar ventilation and prevents atelectasis.
63. Postural Drainage
Administer postural drainage
This is drainage by gravity of secretions from various lung segments
Scheduled 2-3 times daily before meals and at bedtime
Before the procedure, patient may be given a bronchodilator
medication or nebulization therapy to loosen the secretions
Sequence: positioning, percussion, vibration, and removal of secretions
by coughing or suction. Positions are assumed for 10-15 minutes
depending on patient’s tolerance
Position for draining middle to lower lung field: head is lower than a
chest; patient may be placed in Trendelenburg position
Position for draining upper lung field: sitting position at about 45
degrees
Postural drainage should not be performed on pregnant women; on
those with rib or chest injuries; on those with dizziness, fainting, head
or neck injuries; on those with pulmonary embolism or abdominal
surgery
69. Constipation
Constipation is due to stasis of fecal
material in the rectum and sympathetic
nervous system activity
May present as ribbon-like diarrhea and
fecal smearing
Nursing Measures:
Promote ambulation early
encourage high fiber, high f luid diet
Ensure privacy with the use of bedpan or
commode
Administer stool softeners as necessary
70. Urinary Stasis
Immobility leads to inability to
completely empty the bladder
Leads to urinary tract infection and
renal calculi formation
Nursing Measures:
Have patient void in normal position,
if possible
Low calcium diet, increase f luid intake
and increase acid ash residue
71. Depression
Sensory Input
Changes
• This may lead to confusion and
disorientation
• Orient patient frequently and
place clock/ calendar within sight
• Encourage self care that starts
with simple gross activities then
advancing to complex, fine motor
movements
• Support patient with positive
feedback for his efforts and
accomplishments
• Schedule OT and allow visitors as
appropriate
72. ASSISTIVE DEVICES
Crutches
Height of crutch – measure two to three fingers or 2.5 -5
cm below the axilla
Patient should support weight on the handpiece and not
at the axilla: to prevent brachial plexus palsy
Tripod stance: proper standing position with crutches;
crutches are placed about 15 cm (6 inches) infront of the
feet and out laterally, about 15 cm, creating a wide base
Elbows should be f lexed at 20 -30 degrees angle for
correct placement of hand grips
74. Using Crutches:
Sitting and Standing
To sit on a chair
Stand with the back of the unaffected
leg centered against the chair.
Transfer the crutches to the hand on
the affected side and hold the
crutches by the hand bars.
The client grasps the arm of the chair
with the hand on the unaffected side
to support himself.
Lean forward. Flex the hips and
knees, and lower into the chair.
75. stand up from a chair
Hold the hand grips of both
crutches in one hand.
Push off from the chair with
the other hand.
Stand and check your balance.
78. Cane
Types: straight cane and quad cane
Tips should have concentric rings as shock absorber and to
provide optimal stability
Flex elbow 20-30 degrees angle and hold handle
Tip of cane should be 15 cm lateral to the base of the fifth
toe
Procedure:
Hold cane on the good side
Advance cane and affected leg
Lean on cane when moving good leg
When going up the stairs, follow “up with the good, down
with the bad”
79. Walker
Lift and move walker forward 8-10 inches
With partial or non-weight bearing, put weight on
wrists and arms and step forward with affected leg,
supporting self on arms, and follow with good leg
Nurse should stand behind patient, hold onto gait belt
at waist as needed for balance